Comparison of Accuracy in Determining the Root Canal Working Length by Using Two Generations of Apex Locators - An In Vitro Study

A Global Overview on Electronic Apex Locator Use From 1968 to 2023: A Bibliometric Analysis

INTRODUCTION

This bibliometric review analyzed the research trends and main characteristics of articles related to Electronic Apex Locators (EALs).

METHODS

The search was conducted in November 2023 on the Web of Science Core Collection. Narrative and systematic reviews, observational and intervention studies, laboratory, and clinical studies were included. Two researchers selected the articles and extracted the number of citations, year of publication, journal, study design, theme, country, continent, institutions, author, and keywords. Collaborative networks were generated using the VOSviewer software. The relationship between data were determined by Spearman's correlation.

RESULTS

The search resulted in 374 articles, of which 294 were included. Most cited article had 175 citations. The most prevalent journal was the Journal of Endodontics (n = 84). The predominant study design was the laboratory-based (n = 223). The predominant theme was the EALs accuracy (n = 175). Piasecki L was the author with the highest number of articles (n = 11). Only 8.16% of the studies were conducted in deciduous teeth. The country with the most studies was Brazil (n = 46). Asia (n = 107) was the continent with the highest number of publications. There was a weak positive correlation between the number of citations and impact factor (rho = .294), and a strong negative correlation between citations and year of publication (rho = -.710).

CONCLUSIONS

The majority of articles were laboratory-based studies conducted on permanent teeth, focusing on the accuracy of EALs. Future studies should prioritize research on deciduous teeth, systematic reviews, and, notably, clinical trials.

Assessment of dental students' knowledge and performance of master gutta-percha cone selection and fitting during root canal treatment: a pilot study

BACKGROUND

Misconceptions should be detected early in dental students' training to improve their clinical performance. Accordingly, this study aimed to assess undergraduate dental students' knowledge and performance of master gutta-percha (GP) cone selection and fitting during clinical endodontic courses at the College of Dentistry, King Saud University.

METHODS

Ninety-nine undergraduate dental students completed an online survey about their knowledge of master GP cone selection. Forty-five of these students were observed by faculty members in clinical endodontic courses while they fitted master GP cones during root canal treatments. The observers recorded the details of each student's cone-fitting techniques. The data were analysed using t-tests, one-way analysis of variance, and chi-square tests (p < 0.05). Inter- and intra-observer reliability were tested using Fliess' Kappa.

RESULTS SURVEY

All participants had good knowledge of over-extended cone management, while 80.8% knew how to properly manage a short cone. The proper flaring assessment method was selected by 86.9% of the female and 34.2% of the male students, and this difference was statistically significant (p = 0.0001).

OBSERVATION

The students labelled the working length on the master GP cone with an indentation in 64.4% of the cases and by bending the cone 35.6% of the time. Of all students, 84.4% encountered an apical stop, and this rate correlated significantly with the length of the cone on the master apical cone radiograph (p = 0.001). Improper shaping of the canal was the most common cause of ill-fitting cones (83.3%), while 16.7% of the students chose the wrong cone size. The final obturation length was adequate in 80% of the cases; 57.8% of the students were helped by instructors.

CONCLUSIONS

Most students had the basic knowledge required to solve problems related to the selection of master GP cones. However, in the clinical setting, more than half of the students required the assistance of an instructor to adjust their cone's fit. The presence of an apical stop had the most significant effect on the length of the fitted master GP cone on radiography. The most common cause of ill-fitting master cones was improper shaping of the canal.

Apexoconnection: A Novel Technique to Determine Working Length

Purpose

The aim of this study was to evaluate and compare the accuracy of working length (WL) determination when using the conventional electronic WL (EWL) technique versus using the novel Apexoconnection technique involving EWL with a connector (EWLc).

Materials and Methods

Sixty extracted posterior teeth with a total of 118 root canals were selected for the study. The real WL (RWL) of each canal was verified using a dental microscope under 25.6x magnification. Root canal lengths were measured with an apex locator using the attachment device directly attached to the hand file in the root canal and then adding another hand file as a connector between the attachment device and the file in the root canal. The distance from the file’s stopper to its tip was measured using a digital caliper. Statistical analysis was carried out to analyze the data between experimental groups.

Results

The results of the statistical test showed that the differences in the WL determined by either technique and the proper length as determined under the microscope were not statistically significant. The results of the statistical test comparing the groups were also not statistically significant.

Conclusion

In this in vitro study, both the novel and conventional techniques were equally accurate for determining WL when compared with the RWL.